Abstract 14094: Tuberculous Effusive-Constrictive Pericarditis: Prevalence, Predictors and Prognosis
Introduction Effusive-constrictive pericarditis (ECP) is characterized by visceral pericardial constriction in conjunction with compressive pericardial effusion and considered to be an indication for high-risk prophylactic pericardiectomy. There is no information on the prevalence, cytokine profile and outcomes of tuberculous ECP Hypothesis We conducted a prospective study of tuberculous ECP to test the hypotheses that a] it is common; b] it is characterized by a unique cytokine profile; and c] it associated with a high incidence of constrictive pericarditis Methods From July 2006 through July 2009, the prevalence of ECP and serum and pericardial levels of inflammatory cytokines were determined in adults with tuberculous pericardial effusion. Those with ECP as determined by combined pericardiocentesis and cardiac catheterization were monitored until completion of a 6 months course of anti-tuberculosis therapy for the incidence of non-effusive constriction and death. Results Of 123 patients evaluated, 68 had tuberculous pericarditis. The 36 patients (52.9%; 95% confidence interval [CI]: 41.2-65.4) with ECP were younger (29 versus 37 years, P=0.02), had a higher opening right atrial pressure (17.0 versus 10.0 mmHg, P<0.0001), serum concentration of interleukin-10 (IL-10) (38.5 versus 0.2 pg/ml, P<0.001) and transforming growth factor-beta (121.5 versus 29.1 pg/ml, P=0.02), pericardial concentration of IL-10 (84.7 versus 20.4 pg/ml, P=0.006) and interferon-gamma (2,568.0 versus 906.6 pg/ml, P=0.03) than effusive non-constrictive cases. In multivariate regression analysis, right atrial pressure (odds ratio [OR] = 48, 95%CI: 8.7-265; P<0.0001) and IL-10 (OR=10, 95%CI: 1.1, 93; P=0.04) were independently associated with effusive-constrictive pericarditis. The incidence of constrictive pericarditis was 41.6/100 patient years (95% CI: 13.7-95.0) in 21% (5/24); 14.7% (5/34) died at 6 months. Conclusions Effusive-constrictive disease is a common syndrome in tuberculous pericarditis, with a distinctive cytokine profile, a high incidence of constrictive pericarditis and significant mortality rate. d significant mortality rate.
- © 2012 by American Heart Association, Inc.